PRIMARY REPLACEMENT OF THE HUMERAL HEAD IN IATROGENICALLY DISPLACED FRACTURE-DISLOCATIONS OF THE SHOULDER - A REPORT ABOUT 6 CASES

Dislocation of the shoulder is a common injury and may be associated w ith a variety of complications. We report six cases of primary replace ment of the humeral head where closed reduction of a shoulder dislocat ion associated with an undisplaced fracture of the humeral neck led to displacement of the neck fracture. All dislocations examined were ant erior with a displaced greater tubercle fracture. The patients had und ergone closed reduction at of her medical centres and were referred to us because of iatrogenically displaced fracture-dislocations of the s houlder. Three were women and three were men with a mean age of 52.8 y ears (range 38-72). Primary replacement of the humeral head was done i n an average of 9.3 days (range 2-30 days) following the injury. The a verage follow-up period was 30.2 months (range 12-55 months). Postoper ative pain, active range of motion and function were evaluated with th e American Shoulder and Elbow Surgeons Criteria. The forward flexion a veraged 124 degrees, active external rotation averaged 29 degrees and internal rotation (achieved movement) to the second lumbar vertebra. B ecause of the high risk of avascular necrosis and severe collapse of t he humeral head, we conclude that the primary replacement of the humer al head is the superior treatment option in iatrogenically displaced f racture dislocations of the shoulder. (C) 1998 Elsevier Science Ltd. A ll rights reserved.